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HomeMy WebLinkAbout874619 state of Wyoming ) ) SSe ) County of Lincoln AFFIDAVIT OF SU~VIVOR TRUSTEE I, Belinda Latham, being of lawful age and duly sworn according to law, upon my oath, depose and state: That under the date of June 28, 1999, for valuable consideration, William W. Peutz and Patricia A. Peutz, by deed of that date, which deed was duly filed of record in the Office of the Lincoln county Clerk, on July 1, 1999, in Book 432 of Photostatic Records on Page 434, conveyed to Charles Latham or Belinda Latham, Trustees of the Latham Family Trust dated Sept. 14, 1990, the following described property, to-wit: star Valley Ranch RV Park plat No.1, Lot No. 452, as platted and recorded in the official records of Lincoln County, wyoming That by reason of said conveyance aforesaid, the said Charles Latham or Belinda Latham, Trustees of the T.Jatham Family Trust, became the owners of the above described land, and title thereto vested in them continuously from the date of conveyance described in said deed to the date of death of Charles Latham, also known as Charles Griffith Latham, on the 10th day of August, 1999. That by reason of and upon the death of Charles Latham, title to the above described real property vested absolutely in Affiant, Belinda Latham, as the surviving trustee. Affiant avers and certifies that Charles Latham, also known as Charles Griffith Latham, is the identical party named with the Affiant in the aforementioned deed whose death terminated his interest, title and estate in said real property; and Affiant attaches hereto and makes a part of this affidavit, a copy of the Official Certificate of Death of said decedent, duly certified by the public authority in which said death certificate is I.a matter of record. DATED this \~-\-~ day of July, 2001. flLj~ ~~ Belinda Latham Subscribed and sworn to before me and in my presence by Belinda Latham, this \4~~ day of July, 2001. WITNESS my hand and official seal. County of Lincoln Stat. of Wyoming ~~ c». ~~ Notary Publ~c My Commission Expires: lo . 0 S - () , (A6N. ,.., BOOK~~=,~PR PAGE--.L.8._8 _ FŒCE IVED JNCOLN COUNTY CLERK 874619 O I II II I 7 ')~' I?· r.; I .,.~ .' ¡ II (.. <., <I JE f. ~.I",I'- "1' "0' I["¡) ~ ". I~ III\! ¡:. 'jJ /\ tJ I 'H: '\ KEMMEf-1En. WYOMING 51 A TE OF WYOMING DEPARTMENT OF HEALTH r~; 8 9 "" ~" ~ I I~",I ¡,Iii ~ 1'1 " , I ~ T'iI'E ,':OR PAINT' w", I' EAMNIèNT :. aJrCK N< FOR , INSTRUC110NS SEE I\AHDBOOK LOCAL FU NUMBER 1. DECEDENT-NAME FIRST , Gharles STATE OF WYOMING DEPARTMENT OF HEALTH CERTIFICATE OF DEATH LAST 2, SEX Latham Male STATE ALE NUM8ER 3. DAn! Of DE",," ,"". Oorh'toj ugU¡;t 10,Í'J':I9 Utah ~ ~ I ~ " I ~ u ~ ~ ~ " ! ~ ~ ~ ¡ ~ ~ I ~ ~ ~, ~ ¡ I 4, SOCIAl SECURITY MJMBER 528-30-0968 5c.UN RID ..... - 8. DAn! Of BIRTH '''''. Oor. ItJ June 16,1929 7d. COUNTY OF DEATH incoln 12~. ~I(IND OF BUSINESS OR INDUSTRY Ìnsurance III Road MIIdIn SIM'''''''''' STAn Afton, WY ......... IIot ........... . ant."1ding 110 bnrnedlll. caUH. Enl:w UNDEIILVlHG ~E CDUIii... Of-Jr*'ry .....IÌlltillIod'_ .....11.. In ilnlh) lAST DUE TO lOR M A CONSEQUENCE Ofl, ,=:'':...n ION« .... OMIh, I ' ¡k~wk. I 1 1 1 I I I . .. M VðC.7h::l¡d/ .z;, /a~~'b,.., ~ TO lOR M A CONSEQUENCE OFI: .. DUE TO IDR M A CONSEQUENCE OF , c1 MRT II. OTHER $tGNIFlCANT CONDlTIONB·Çondltklna contribul~ '" ..... but not "I.-cI to c.uee ClNen In IWIT I. " 21. MANNER Of DEAtH ....... 0- , -- :w.. DAte OF INJURY ,-. Oor. -I 3Ob. TIUe OF INJURY 3Oc. INJURY ¡a WORK? (SpecIIy ,.. Of no, 0) ...... - "DCouId not be ~~ 3OI.LQCAl1ON (8nel and Number 'at ""'. RauIe Nurabe" City or Town. .....) ~ ~ VR N'I9 .... 11197~5M ..- -- This Is a true and exact'reproduction of the document on file in the office of Vital Records Services, ChØyenne,Wyom[ng. DATE ISSUED: SEP - 8 '999 q:..:u.h ~~ Luclnda'McCaffre{ / Deputy State Registrar 092182 Thi. copy i. not valid unle.. prepared on paper with an engraved border displaying the date. seal and .ignature oflhe Deputy State Registrar, .~...,,~....